The State of Public Health in South Sudan

Less than 18 months into its life as an independent nation, South Sudan is facing a desperate struggle for survival. Because the terms of its separation from Sudan were not decided before independence, negotiations have dragged on over issues including borders, security arrangements, and the qualifications for citizenship, diverting attention from the urgent task of development. Most damagingly, the two nations have failed to cooperate on oil production, the mainstay of their economies. Anger over the high price Sudan was demanding to use its pipeline prompted the government of the Republic of South Sudan (GRSS) to shut off oil production entirely in January 2012. Although a compromise was reached in August, implementation stalled until a broader agreement was signed by the two countries in late September.

The implications for health development in South Sudan are stark. Even before the oil shutdown, international donors had paid for and delivered most health services. However, talks had been ongoing to transfer to a more sustainable system in which the GRSS assumed more responsibility for the health needs of its citizens. Donors spoke of the importance of moving away from a top-down system centered on emergency relief and primary health care delivery, mainly administered by international nongovernmental organizations (NGOs). Instead, the objective was to move to a new phase focused on developing health systems that would increasingly be managed by South Sudanese themselves. These plans were put on hold by the oil shutdown and the calamitous economic crisis it triggered. Donors feel that South Sudan has regressed in the period since independence, and they apportion a lot of the blame for the dire situation on the government of South Sudan.